Membership Application – Online Form – Part One

Use the form below, to submit your application online, for membership in the Michigan Boer Goat Association, Inc. The information you provide on your application will not be published, unless you have specifically opted to release your member profile for publication in the MBGA Member Directory and Newsletter.

ONLINE SUBMISSION FORM:

Email:*

APPLICATION TYPE–Check One

New

Renewal

MEMBERSHIP LEVEL–Check One

Youth

Farm/Ranch

MEMBERSHIP PROFILE–Please provide the following
information for your membership record

First Name (limit 2 names):

Last Name:

Street Address:

Mailing Address:

City, State, Zip Code:

Contact Phone Number:

Contact Email Address:

Farm/Ranch Name:

Website URL:

MEMBERSHIP COMPLIANCE VERIFICATION–Applicants must verify that they have read, understand, and agree to the requirements for membership

YES - I accept the full requirements for Membership

YES - I accept the MBGA Corporate By-Laws

YES - I accept the "Hold-Harmless" Agreement

AUTHORIZATION TO PUBLISH–Check All That Apply

DO NOT PUBLISH

PUBLISH ALL

Name (first/last)

Street Address (street/city/state/zip)

Mailing Address (p.o. box/city/state/zip)

Contact Phone Number

Contact Email Address

Farm/Ranch Name

Website URL

ADDITIONAL INFORMATION–This information intended for internal use only and will not be published or exchanged

BREEDING STOCK: List number of animals you maintain for breeding

BUTCHER STOCK: Approximate number of goats you sold for butcher in the past year:

RANCH MEMBERSHIP: List the other members living in your household (one name per line)

Verify your online application by entering the CAPTCHA Code shown in the image below. If you are having difficulties making out the numbers or letters depicted, click the small icon located just to the upper right of the image box to display a new code.

Once your information has been submitted, you will be redirected to the
payment portion of this online transaction.